Emmanuel International

By Andrew Mellen, Emmanuel International

Andrew Mellen has been the relief programme manager with EI Malawi since 2003. With a background in agriculture, he previously worked as an organic farm manager in the UK. He currently lives in Zomba, Malawi with his wife and three children.

In this article, EI shares their experiences of working with a community whose active involvement in relief has played a pivotal role in responding to chronic food insecurity complicated by HIV/AIDS.

Emmanuel International (EI) is a faith based international NGO, with its head office in Toronto, Canada. Emmanuel International is operational in 11 countries worldwide, with a major programme in Malawi. Other programme countries include Tanzania, Uganda, Sudan, Haiti, Brazil and the Philippines. Formed in 1975 in response to several disasters around the world, EI's strategy has always been to work through local partners, strengthening the church to "meet the spiritual and physical needs of the poor in accordance with the Bible."

Work in Malawi

HBC in Mbalika village

Emmanuel International became operational in Malawi in 1986, after a request from the Evangelical Baptist Church of Malawi to help them respond to the Mozambique refugee crisis when over a million people crossed the border into Malawi to escape the war. EI assisted the church with resources and staff to help meet the needs of the refugees in one area, and then gradually began development and spiritual projects, working with the local population through the church.

After the war finished in 1992, the refugees returned back home and EI continued its development work in Malawi, while also becoming involved in food relief work with WFP. The main development projects being implemented by EI are in the areas of food security, health and nutrition, water/sanitation and fertiliser for work. Currently EI is working in four districts of southern Malawi, namely Zomba, Machinga, Mangochi and Balaka. The head office in Malawi is in Zomba town, the former capital. Paul Jones, who is from Canada, is the country representative. Over the years, the projects have grown or shrunk, depending on opportunity and the availability of funding. At present, the workforce numbers around 160 national staff, assisted by eight international staff.

EI and relief work

During the 2002/3 food security crisis, EI became operational in relief once again, and was involved in the formation of the Joint Emergency Food Aid Programme (JEFAP) - a consortium of NGOs in Malawi working together on WFPs EMOP (emergency operation) general distribution of food aid to vulnerable populations. EI also became involved as an implementing partner in the USAID funded C-Safe1 group of NGOs. While the largescale general food distributions have been phased out, EI remains an implementing partner with WFP under their three-year PRRO (Protracted Relief and Recovery Operation) in Malawi. EI has also ongoing partnerships with USAID and other NGOs in the new five year Development Assistance Programme (DAP).

Challenges of implementation

Clients receiving HBC
in Mbalika village

Malawi faces a complex mix of problems that reinforce poverty and inhibit development. A high population density - particularly in the south - together with depleted soils are, on their own, a recipe for chronic food insecurity. Other factors, like the prevalence of HIV and lack of crop diversification, exacerbate the problem. Dependency on aid is something all parties want to avoid, so all WFPs partners in Malawi are encouraged to get maximum 'added-value' for the food given, by forging linkages between food-for-work (FFW) type projects and other interventions. In one example from EI's projects, participants in FFW carried out the heavy work of cultivation on community gardens while other households, targeted for aid under orphans or chronically ill projects, assisted with light work. Thus both benefited from the food produced. The village chief has made land available to grow maize, cassava and rice, along with vegetables that are planted in the dry season.

Involving the community in the targeting has been essential to the acceptance of the programmes, particularly as resources can seldom meet the needs of every household that falls into the target category. With assistance from EI's field staff, the committee in each village consider the following criteria to select households that receive assistance:

Food insecurity, with a range of inclusion and exclusion criteria

Income-generating capacity of the household

Households caring for chronically ill persons

Households keeping orphans or other vulnerable children.

In Mbalika village where EI are working, those interviewed stated that there were around 30 chronically ill HH (households) and over 40 HH with orphans and vulnerable children (OVC) out of a total of 378 HH in the village. However, they only had resources to support 10 chronically ill and 17 OVC households. The committee has had to make hard choices with regard to targeting the neediest, particularly as there is no home based care (HBC) system in the village, making decision making all the more difficult.

Pilot programme to support TB treatment

TB patient
(BMI 13.9)
with his
wife

EI has also been part of a pilot project with WFP and the national tuberculosis (TB) programme, assisting people diagnosed with TB in four selected districts of Malawi. Patients diagnosed with TB at the Machinga District Hospital are placed on the routine 8-month directly-observed treatment (DOT) regime. Through EI, WFP provides a monthly household food ration to each household with a TB patient, part of which is a nutritionally-dense corn soya blend (CSB) plus a vegetable oil mix intended solely for the patient. EI receives food from WFP, repackages it into the exact ration sizes, and delivers it to the local health centres around the district. Thus, when the patient goes to collect his month's supply of medicine and to be weighed, he or she also collects a monthly food ration.

This intervention is being tested to see whether it helps in two ways, first by encouraging patients to stick with the treatment regime until the course is completed, and secondly to see if the food reduces the high death rate previously experienced in the early months of treatment. Once the scheme has been operational for a period of time, a direct comparison can be made between a cohort of patients who have received the food aid, and another nonrecipient group that has never received food as part of the programme. Anecdotal evidence from health centre staff indicates, so far, that the food aid is having two effects. Patients diagnosed are being retained in the treatment programme much better than before. Also, as news of the food entitlement has spread, more people with symptoms like longlasting coughs are presenting themselves for diagnosis, in order to try and qualify for the food!

The collection and analysis of the data on deaths during treatment is still being carried out and a paper on this should be published later this year. Even if, as expected, a reduced death rate during the treatment period is found, it will require further investigation to discover exactly how the food has helped. Is there a direct benefit to the patient in terms of better nutritional status helping them to tolerate the drug treatment? Or is it simply a case of the food acting as in incentive which keeps the patient on the treatment? All that can be concluded, so far, is that both the health workers, and the 370 or so patients currently receiving food, are very happy to be involved in this project.